Provider Demographics
NPI:1316514995
Name:MORENO GUTIERREZ, MARCIAL ARTURO (MD)
Entity type:Individual
Prefix:
First Name:MARCIAL
Middle Name:ARTURO
Last Name:MORENO GUTIERREZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1010 JAMES ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:WESLACO
Mailing Address - State:TX
Mailing Address - Zip Code:78596
Mailing Address - Country:US
Mailing Address - Phone:718-963-7956
Mailing Address - Fax:718-963-7957
Practice Address - Street 1:208 STARR ST
Practice Address - Street 2:
Practice Address - City:MERCEDES
Practice Address - State:TX
Practice Address - Zip Code:78570
Practice Address - Country:US
Practice Address - Phone:956-514-1643
Practice Address - Fax:718-963-7957
Is Sole Proprietor?:No
Enumeration Date:2021-06-10
Last Update Date:2024-07-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXU9316208000000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics